Michigan Department of Insurance and Financial Services Expands Online Complaint Form Features to Include Health Care Appeals

LANSING – Consumers now have an additional way to appeal decisions made by their health insurance carriers. One year after DIFS released an online tool to allow the filing of electronic complaints, DIFS is expanding the tool to include the consumer’s right to appeal health care service denials.

The Patient's Right to Independent Review Act (PRIRA) is a Michigan law that provides patients with appeal rights due to adverse determinations made by health insurance carriers regarding a denial, reduction, or termination of health care services. The PRIRA external review process is available after the patient has exhausted the health insurance carrier's internal grievance process.

“One of our goals every year is to provide more online services to assist consumers and streamline processes,” said DIFS Director Patrick McPharlin. “This tool being expanded is just another example of our mission to protect and help Michigan consumers with issues that arise during sometimes stressful situations.”

In 2017, DIFS Office of General Counsel reviewed over 900 PRIRA appeals.